Provider Demographics
NPI:1205292562
Name:LAWSON, JEFFREY RYAN (DPT, CSCS, FNS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RYAN
Last Name:LAWSON
Suffix:
Gender:M
Credentials:DPT, CSCS, FNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BIRCHWOOD RD
Mailing Address - Street 2:APARTMENT B
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-9738
Mailing Address - Country:US
Mailing Address - Phone:207-253-9348
Mailing Address - Fax:207-373-0908
Practice Address - Street 1:49 TOPSHAM FAIR MALL RD
Practice Address - Street 2:SUITE 25
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1734
Practice Address - Country:US
Practice Address - Phone:207-253-9348
Practice Address - Fax:207-373-0908
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-01
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist